Employee Guide to 2021 Benefits Guide - Open Enrollment: November 9th - November 20th - Elkhart Community ...
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Employee Guide to
2021 Benefits
Guide
Effective Plan Year: January 1 – December 31, 2021
Open Enrollment: November 9th – November 20th
Table of Contents
2021 Open Enrollment ...................................................................................................................................................................... 2
2021 Benefit Highlights ..................................................................................................................................................................... 2
MyElkhartBenefits.com ..................................................................................................................................................................... 3
Terms You Should Know.................................................................................................................................................................... 5
Medical & Rx Drug Benefits insured by:............................................................................................................................................ 6
Rx Help Centers ................................................................................................................................................................................. 8
UMR Member Portal Resources........................................................................................................................................................ 9
Additional Rx Resources .................................................................................................................................................................... 9
Health Savings Account ................................................................................................................................................................... 10
Dental Benefits ................................................................................................................................................................................ 11
Clinic ................................................................................................................................................................................................ 12
Critical Illness................................................................................................................................................................................... 13
Hospital Indemnity .......................................................................................................................................................................... 14
Flexible Spending Accounts ............................................................................................................................................................. 15
Life and Disability Benefits .............................................................................................................................................................. 15
Employee Assistance Program ........................................................................................................................................................ 16
Employee Enrollment Guide ........................................................................................................................................................... 17
Contacts........................................................................................................................................................................................... 19
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases.
2021 Open Enrollment
The health and financial security of you and your family is important to us. Our benefit program provides a variety of
plans that can enhance the lives of you and your family – both now and in the future. As an eligible employee, you will
be asked to make decisions about the employee benefits described in this booklet. This guide provides information
to enable you to effectively enroll in your benefits. Take time to read it carefully and use the available resources to
ensure you make the decisions that are right for you and your family.
The Open Enrollment period is an opportunity for eligible employees to enroll in or make changes to your benefits for
the upcoming year. This year Open Enrollment is November 9th – November 20th. Please refer to your Enrollment
Instructions for a step by step guide to the enrollment process
This is the only time during the year that you are eligible to make benefit plan changes unless you have a qualifying
life event that allows you to change your benefits mid-year. Changes made during Open Enrollment will be effective
January 1,2021.
2021 Benefit Highlights
Medical Plan
• No Plan design changes
• No employee premium changes
• UMR remains the medical plan administrator
• Enhanced UMR customer service
• New UMR customer service phone number
• New ID cards for all plan participants effective 1/1/21
Prescription
• Generic and Preferred Brand prescriptions will now have a 10% coinsurance after deductible instead of 20%
• Maintenance drugs for chronic conditions must be filled either at CVS locations or by mail order –
• True Member Out of Pocket Program - Members using a coupon to fill medication will only be credited their
true out of pocket expenses toward their deductible.
• CVS Starter Fill Program – limits prescription fills to 14 or 15 days for drugs with a high prevalence of side
effects and potentially poor tolerability that can lead to discontinuation of drug and unnecessary out of
pocket expenses for unused drugs
• Higher dose prescriptions that have a lower dose alternative at a lower cost will be replaced with the lower
dose (i.e. Doxycycline 150 mg tab for $684.12 vs 75 mg tab $50.11)
• Multivitamins are excluded from the formulary
Dental
• No plan design changes
• No employee premium changes
• Delta Dental remains dental carrier
This year we will be having a Passive Open Enrollment. This means that with the exception of the Health Care
Reimbursement and Dependent Care Reimbursement Accounts, your current elections will roll over for 2021. If
you would like to make any changes to your current elections or if you would like to elect the Health Care
Reimbursement or Dependent Care Reimbursement Accounts, you will want to log in to PlanSource to do so.
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 2
MyElkhartBenefits.com
The NEW Elkhart Community Schools portal is ready!
You can view it from anywhere you have internet
access—your computer, iPhone, iPad, Android phone or
tablet. The portal not only serves as your benefit hub,
but you can also learn how best to use your benefits to
save you time and money.
Have you ever…
• Needed a copy of your ID card?
• Been asked by your spouse what your deductible is?
• Wanted tips on how to make the most of your benefits?
• Arrived at the dentist and realized you have no idea who your carrier is?
It provides:
• Access to robust benefit information,
• Side-by-side plan comparison tools,
• Library of HR and benefit forms,
• Educational and informational articles,
• Pinterest-style photos and links to spotlight key programs or events,
• Links to all providers, and
• So much more.
We are thrilled to offer you and your family this innovative tool.
Visit MyElkhartBenefits.com to get started today.
Have questions or need help? Contact your benefits representative.
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 3
In order to access
MyElkhartBenefits.com
Download the
Elkhart Community Schools
Pocketpal Mobile App!
To download The Pocketpal, go to the Apple
App Store or the Google Play Store, and
search for “The Pocketpal” and look for this
logo:
After The Pocketpal is downloaded, you will need
this information:
• Name and Email Address
• List of the benefits you are enrolled in
• Your ID Cards
To Set up Elkhart Community Schools Pocketpal mobile app, follow these steps:
1. Click Create Account and then enter 5. Identify Your Class by selecting Full Time,
Company ID: ElkhartCS then click Next.
Click Next. 6. Select the benefits you would like to be able
2. Read and accept the disclaimer by scrolling to view on The Pocketpal and click Next.
down and clicking the box next to I agree to 7. Load your ID cards into The Pocketpal.
the terms and conditions. Click Next. Follow the directions in the app, and
3. Select your current employment status. If click Continue Setup when finished (or to
you are currently employed by Elkhart skip this step). ID Cards can be added at any
Community Schools or you are the time.
dependent of an employee, click Yes. 8. When you are ready, click Finalize Account
4. Then Enter your Name and Email address and read the welcome message. Click
and click Save. Pocketpal Home Screen and you are in the
app!
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 4
Terms You Should Know
Benefit Eligible. All eligible employees who work at least 30 Non-Network Benefits (Out-of-Network). Doctors or
hours per week and certified staff who work at least 20 hours hospitals who are not in the network do not accept UMR’s
per week are eligible to participate in the employee benefit approved amount. You will be responsible for paying the
plans. For the Medical and Dental plans, covered dependents difference between the provider’s full charge and your plan’s
include your legal spouse and children to the end of the year approved amount. This is called balance billing.
of their 26th birthday.
Preventive Care. Preventive care is the care you receive to
Proof of Dependent Eligibility. To ensure that only those who prevent illnesses or diseases. Providing these services at no
are eligible enroll in Company benefits, Elkhart Community cost is based on the idea that getting preventive care, such
Schools requires you to submit proof of dependent eligibility as screenings and immunizations, can help you and your
when you enroll a dependent in any ECS benefit for the first family stay healthy. Services will be paid at 100% when you
time. use a participating provider.
High Deductible Health Plan (HDHP). A HDHP features Qualified Life Event. Employees may add/remove/make
higher annual deductibles (for 2021, a minimum of $1,400 for benefit changes during the Open Enrollment period which is
self and $2,800 for family coverage) than traditional health held annually. However, it is recognized that circumstances
plans, such as a preferred provider organization (PPO) or may occur that may cause a need for changes to your health
health maintenance organization (HMO) plan. With the benefits. Employees have 30 days from the date of a qualified
exception of preventive care, covered employees must meet life event to make changes/updates. Examples of life events
the annual deductible before the plan pays benefits. HDHPs, include birth or adoption of a child; marriage or divorce;
however, generally have significantly lower premiums than death; loss of coverage; and employment status change.
PPOs, HMOs or other traditional plans.
Employees can log into PlanSource to request change(s). In
Deductible. The amount you pay for covered health care addition, you will need to provide documentation to the
expenses before your insurance starts to pay. For example, insurance secretary that reflects the need for change(s)
with a $2,000 plan year deductible, you pay the first $2,000 before benefits can be approved.
covered services.
Plan Compliance Notifications. Federal Required Notices
Coinsurance. The percentage of costs of a covered health including but not limited to the HIPAA Privacy and Security,
care service you pay (for example 20%), after you have paid Certificate of Creditable Coverage for Medicare and Market
your plan year deductible. “Exchange” Notices. Health Care Reform Notices are
available online or via paper, free of charge, upon request.
Out-of-Pocket Maximum. The most you have to pay for Please contact the Insurance Secretary with questions.
covered services in a plan year. After you spend this amount
on deductibles and coinsurance, your health plan pays 100%
of the costs of covered benefits.
Network Benefits (In-Network). In-network providers agree
to accept the UMR approved amount for their services. You
will see these savings listed as the “discounted amount” on
your Explanation of Benefits statements.
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 5
Medical & Rx Drug Benefits insured by:
4 Medical Plan Options
HDHP 1 HDHP 2
Effective 01/01/2021
Premium Non-Premium Non-Network Premium Non-Premium Non-Network
Network Network Benefits Network Network Benefits
Your costs are summarized below Your costs are summarized below
Physician Office Visit 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Specialist Office Visit 20% after Ded 30% after Ded 50% after Ded 20% after Ded 30% after Ded 50% after Ded
Deductible Non-Embedded Non-Embedded
Individual $2,000 $4,000 $3,000 $6,000
Family $4,000 $8,000 $6,000 $12,000
Coinsurance 20% 30% 50% 20% 30% 50%
Out-of-Pocket Maximum Non-Embedded Non-Embedded
Individual $3,000 $5,000 $4,000 $6,000
Family $6,000 $10,000 $7,150 $12,000
Preventive Care
Services include but are
not limited to: Routine
Exams, Routine and
Non-Routine
Mammograms, 100% Covered 50% after Ded 100% Covered 50% after Ded
Pelvic Exams, Pap
testing, Immunizations,
Annual diabetic eye
exam, Routine Vision
and Hearing exams
Hospital Services 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Out-Patient Services 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Maternity Services 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Emergency Room
20% after Ded 20% after Ded
Services
Urgent Care Centers 20% after Ded 20% after Ded
Mental & Nervous
InPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
OutPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Substance Abuse
InPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
OutPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Retail Prescription Drugs
Generic 10% after Ded 50% after Ded 10% after Ded 50% after Ded
Preferred 10% after Ded 50% after Ded 10% after Ded 50% after Ded
Non-Preferred 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Mail Order Prescription
Drugs
Generic 10% after Ded Not Covered 10% after Ded Not Covered
Preferred 10% after Ded Not Covered 10% after Ded Not Covered
Lifetime Maximum
Medical Unlimited Unlimited
Surgical Treatment of
Unlimited Unlimited
Morbid Obesity
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 6
Medical & Rx Drug Benefits insured by:
4 Medical Plan Options
HDHP 3 HDHP 4
Effective 01/01/2021
Premium Non-Premium Non-Network Premium Non-Premium Non-Network
Network Network Benefits Network Network Benefits
Your costs are summarized below Your costs are summarized below
Physician Office Visit 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Specialist Office Visit 20% after Ded 30% after Ded 50% after Ded 20% after Ded 30% after Ded 50% after Ded
Deductible Embedded Embedded
Individual $4,000 $8,000 $5,000 $10,000
Family $8,000 $16,000 $10,000 $20,000
Coinsurance 20% 30% 50% 20% 30% 50%
Out-of-Pocket Maximum Embedded Embedded
Individual $5,000 $16,000 $6,500 $20,000
$5,000 Individual $16,000 Individual $6,500 Individual $20,000 Individual
Family
$10,000 Family $32,000 Family $13,000 Family $40,000 Family
Preventive Care
Services include but are
not limited to: Routine
Exams, Routine and
Non-Routine
Mammograms, 100% Covered 50% after Ded 100% Covered 50% after Ded
Pelvic Exams, Pap
testing, Immunizations,
Annual diabetic eye
exam, Routine Vision
and Hearing exams
Hospital Services 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Out-Patient Services 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Maternity Services 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Emergency Room
20% after Ded 20% after Ded
Services
Urgent Care Centers 20% after Ded 20% after Ded
Mental & Nervous
InPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
OutPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Substance Abuse
InPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
OutPatient 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Retail Prescription Drugs
Generic 10% after Ded 50% after Ded 10% after Ded 50% after Ded
Preferred 10% after Ded 50% after Ded 10% after Ded 50% after Ded
Non-Preferred 20% after Ded 50% after Ded 20% after Ded 50% after Ded
Mail Order Prescription
Drugs
Generic 10% after Ded Not Covered 10% after Ded Not Covered
Preferred 10% after Ded Not Covered 10% after Ded Not Covered
Lifetime Maximum
Medical Unlimited Unlimited
Surgical Treatment of
Unlimited Unlimited
Morbid Obesity
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 7
Rx Help Centers
This service is at no cost to you and your covered family members as long
as you are participating in an Elkhart Community Schools medical plan. You
have the option to use the service for your extended family as well,
including your in-laws, for $50 a month. If you or your family members’
medications qualify, you can save significantly on your cost.
If you are enrolled in a medical plan and are prescribed expensive
medications and/or those drugs classified as specialty, the RX Help Center (RXHC), a prescription drug
advocacy service, may be a solution for helping them be affordable. In some cases, the Rx Help Center can
even help those whose prescription drugs are not overly expensive. Cost savings may be available if you are
spending more than $75 for a single prescription or $100 or more per month for all of your prescriptions. You
are not required to use this service.
RXHC does not guarantee it can reduce your prescription costs. An initial study will find out. If savings are
available, RXHC can significantly lower your prescription drug costs. The concierge service is not an overnight
solution as it may take from 14 to 30 days to implement.
Examples include but are not limited to:
• Xaralto • Singulair • Levothyroxine • Janumet
• Vivanse • Lisinopril • Prozac • Latuda
• Lyrica • Enbrel • Restasis • Lipitor
• Cymbalta • Suboxene • Effient • Plaavix
• Crestor • Celebrex • Eliquis • Seroquel
• Nexium • Cialis • Flovent • Victoza
• Spiriva • Advair Discus • HFA • Viagra
• Invokana • Advair • Welchol
• Humira • Albuterol • Abilify
• Concerta • Dilantin • Atorvastatin
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 8
UMR Member Portal Resources (https://member.umr.com)
View Your Benefits Check Claim Status and Details
Find information about the name of your health plan, the Check the status to see if your claim has been filed with
benefit plan year dates, and which of your family members Anthem and what the status is. You can also view the
are covered. You can also see your specific benefit details details such as billed charges, Anthem discounts, paid
such as deductibles, out-of-pocket limits, coinsurance, etc. amounts and your member responsibility.
Request ID Cards Health Cost Estimator
Request an ID Card for yourself and/or covered dependents Cost & Care Finder helps you compare costs for common
via email, mail or fax or simply print one from the website. health care services. Estimates are based on what your plan
covers, so you get a true picture of what you’d pay.
Find a Doctor
Find UMR network doctors, hospitals and facilities in your
area and learn more about providers such as specialty,
quality snapshot, location and contact information.
Manage Pharmacy Benefits
You can locate pharmacies, search your drug list, price
medications, switch to home delivery and see drug alerts.
Additional Rx Resources
OneRX is a free mobile app that combines GoodRx can save you up to 80% on
coupons and insurance discounts to figure out your prescriptions.
just how little you have to spend on a You can download their free
prescription drug. The app figures out how mobile app or go to their website
much you should save based on your insurance by taking at www.goodrx.com to:
the information from your insurance card (submitted either
• Search and compare prices
by picture or by being put in manually). It then combines
• Save your prescriptions to track prices, receive
how much your insurance will cover with coupons and
savings alerts and refill reminders
allows you to compare prices at pharmacies near you. You
• Get free coupons redeemable at the pharmacy
simply type in the drug name and confirm Rx details. Then
compare prices and choose a pharmacy nearby. At the
Although the costs you pay for your prescriptions will not
pharmacy you can then redeem your offer.
automatically run through your health plan, you will be able
to file a claim to get it applied to your deductible and out-
NeedyMeds is a non-profit information
of-pocket maximum.
resource dedicated to helping people
locate assistance programs to help them
afford their medications and other healthcare costs.
NeedyMeds is not a program, so you can't sign up. They are
an information source where programs are listed that may
provide individuals with assistance. You apply directly to
those programs. Go to www.needymeds.org for more
information.
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 9Health Savings Account
A Health Savings Account (HSA) is a tax-advantaged What Are the 2021 IRS Maximum Contributions?
checking account that is always combined with a High
Deductible Health Plan (HDHP).
2021 IRS Maximum Contributions
• An HSA provides a tax-free way to save for current
and future medical expenses Employee $3,600
• HSA contributions are pre-tax or tax-deductible up
Family $7,200
to the annual HSA limits
• All HSA earnings and interest are tax free Catch Up: Age 55+ $1,000
• Qualified withdrawals are tax free *The sum of all contributions cannot exceed the IRS maximum.
• Money not used in your Health Savings Account can
be rolled over year after year If You Will Be Turning 65
• Funds can be invested
Active employees turning 65 have the option to accept or
decline enrollment in Medicare, including Medicare Part A.
To qualify for an HSA, you must meet the
• Employees who enroll in any part of Medicare are no
following requirements, as defined by the IRS: longer eligible to make or receive contributions to an HSA
• You must be covered under a qualified Consumer • If you elect Medicare at age 65, your maximum HSA
Driven Health Plan (All 4 ECS HDHPs are qualified) contribution for the year you elect will be prorated by the
• You cannot be covered under traditional health number of months you were not enrolled in Medicare
insurance including a PPO plan, Medicare, TRICARE, • Employees who decline enrollment may continue to make
or a Spouse’s General-Purpose FSA plan and receive contributions to an HSA
• You cannot be claimed as a dependent on someone • Qualified distributions remain tax free regardless of your
else’s tax return eligibility to contribute
• Non-qualified distributions are taxable but no longer carry
How Your Health Savings Account (HSA) can be a 20% penalty after age 65
funded? • Medicare Part(s) A, B, D and Medicare HMO premiums
may be paid or reimbursed with tax-free HSA dollars. You
• Contributions can be made with pre-tax money
cannot use your HSA to pay for Medigap premiums.
through payroll deductions which can be stopped,
started, and/or changed during the calendar year
• Contributions can be made post-tax (tax benefits
would be realized when filing your tax return).
• Contributions can be made by the employee, the
employer or any other person on behalf of the
employee
• Contributions can be made in a single lump sum
outside of payroll or multiple contributions
How You Can Use Your Health Savings Account
(HSA) funds?
• Your HSA funds can be used for you, your spouse
and your dependent children if you claim them on
your tax return
• HSA funds can be used for all qualified medical,
dental, vision and prescription expenses. Over-the-
counter medications are qualified expenses if you
have a prescription from your provider. Qualified
expenses can be found at www.irs.gov. Publication
502
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 10Dental Benefits
Administered By:
Did you know that your dentist can often tell whether you are at risk for chronic health conditions? It’s true! Regular
dental checkups can do more than keep your smile attractive. They can also tell dentists about your overall health
including whether or not you may be at risk for chronic diseases.
The plan is designed to provide you and your dependent family members with preventive, basic, and major dental
care. Delta Dental has two levels of participating providers – PPO or Premier. You may visit either type of
participating provider.
If you receive services from a nonparticipating dentist, you might have higher out of pocket costs. You will be
responsible for making sure that the dentist completes a claim form and submits it to Delta Dental. Delta Dental will
pay you, and you will be responsible for paying the provider. You can log onto deltadentalin.com for current
provider information.
Delta Dental
Annual Deductible PPO Dentist Premier Dentist Nonparticipating
Individual - $50
Individual $25 Dentist
Family $50
Annual Plan Maximum $1250
Diagnostic and Preventive – No Deductible
Diagnostic and Preventive Services – includes exams,
80% 80% 80%
cleanings, fluoride and space maintainers
Emergency Palliative Treatment – to temporarily relieve pain 80% 80% 80%
Sealants – to prevent decay of permanent teeth 80% 80% 80%
Brush Biopsy – to detect oral cancer 80% 80% 80%
Radiographs – X-rays 80% 80% 80%
Basic Services – After Deductible
Minor Restorative Services – fillings and crown repair 80% 80% 80%
Endodontic Services – includes root canals 80% 80% 80%
Periodontic Services – to treat gum disease 80% 80% 80%
Oral Surgery Services – extractions and dental surgery 80% 80% 80%
Major Restorative Services - crowns 80% 80% 80%
Other Basic Services – miscellaneous services 80% 80% 80%
Relines and Repairs – to bridges implants, and dentures 80% 80% 80%
TMD Treatment – treatment of the disorder of the
80% 80% 80%
Temporomandibular joint, including related films
Major Services – After Deductible
Prosthodontic Services – includes bridges, implants and
80% 80% 80%
dentures
Orthodontic Services
Orthodontic Services – includes braces 60% 60% 60%
Dependent Children Dependent Children Dependent Children
Orthodontic Age Limit
up to age 19 up to age 19 up to age 19
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 11Clinic
Elkhart Community Schools has a comprehensive wellness program that focuses on the physical and emotional health of our
employees. We want our employees to lead balanced lives and commit to developing lifelong habits of wellness. The Clinic is
available to all employees and retirees who are enrolled in the Elkhart Community Schools Medical Plans. It is located at 2424
California Road, Elkhart, IN 46514.
CONTACT US
Phone: (574) 262-5800 Fax: (574) 262-5803
CLINIC HOURS
Monday 8 am – 6 pm
Tuesday 7 am – 4 pm
Wednesday 7 am – 4 pm
Thursday 8 am – 6 pm
Friday 7 am – 11 am
HEALTH SERVICES
Most services are covered at low or no cost. Services include:
• Clinic visits – annual physicals, musculoskeletal visits, sick visits, and wellness coaching.
• Chronic disease management – support from clinical staff to better manage conditions such as diabetes, high
cholesterol, asthma and others.
• Health risk assessments – helps identify targeted concerns and preventive health goals.
• Referrals and care navigation – support in the coordination of specialty referrals when needed, as well as the
management of follow-up care.
• On-site pharmacy services – features a formulary of the most commonly utilized medications. There are approximately
50 generic drugs available at low or no cost.
• Lab draws – conveniently available on-site with rapid results turnaround.
INCENTIVE-BASED WELLNESS ACTIVITIES
You will have an opportunity to earn HSA contributions for completing certain wellness activities. The following activities can
be completed by you and will result in funds being deposited to your HSA Account:
Incentive Activities Possible Reward
Complete a Comprehensive Physical, Including:
• Blood Test
• Health Profile questionnaire $100
• 30-60 minute visit with your provider(s) for
medical evaluation and health coaching
Achieve your individually tailored health goals Up to $425
See a specialist referred by an Activate provider and
$200
keep the appointment
Total Annual Incentive Amount Possible Up to $725
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 12Critical Illness
Administered by:
Elkhart Community Schools offers Voluntary Critical Illness Insurance. Employees can elect a $10,000 or $20,000 benefit for
themselves, $5,000 or $10,000 for their spouses and $2,500 or $5,000 for children.
A Critical Illness policy provides a lump sum cash benefit upon the diagnosis of a critical illness. Examples of critical illness that
would pay a cash benefit are.
• Invasive cancer • Blindness
• Carcinoma in situ (25%) • Renal (kidney) failure
• Heart attack • Major organ failure
• Stroke • Advanced Alzheimer’s disease (25%)
• Coronary artery disease (25%) • Parkinson’s disease (25%)
• ALS (Lou Gehrig’s disease) • Multiple sclerosis
• Benign brain tumor
Additional Critical Illness Benefits:
• Multiple benefits* – Provides benefits when diagnosed with a different covered condition.
o A 180 day separation period applies.*
• Recurrence benefit** – Provides additional benefits for subsequent or same covered conditions for which a member has
received a previous payment (a 12-month separation period applies).
• Health Screening Benefit – Benefit of $50 per covered person, per calendar year, for a health screening or diagnostic test.
o Eligible tests include (but are not limited to) mammography and certain blood tests.
• Pre-Existing Conditions – 12 months prior to effective date, pre-ex for 12 months
• Auto claim – If you have an eligible Life, AD&D or Disability claim, Cigna will automatically submit your Critical Illness
claim for you, so you don’t have to.
• Portable - You can take your coverage with you if you retire or leave your company prior to age 100.
* Exclusions or limitations may apply. Please see your Benefit Summary for details.
** The Simple File process is based on a one-time assessment of the initial claim documentation for the primary claim. Any subsequent events would not be identified, and the customer
will need to submit a claim for any voluntary benefits.
Monthly Rates
Employee Critical Illness Spouse Critical Illness
EE Attained Age $10,000 $20,000 EE Attained Age $10,000 $20,000
0-24 $3.20 $6.40 0-24 $2.07 $4.14
25-29 $3.74 $7.48 25-29 $2.24 $4.48
30-34 $5.06 $10.12 30-34 $2.78 $5.56
35-39 $7.32 $14.64 35-39 $3.74 $7.47
40-44 $9.44 $18.88 40-44 $4.78 $9.56
45-49 $13.22 $26.44 45-49 $7.05 $14.09
50-54 $17.78 $35.56 50-54 $10.39 $20.78
55-59 $23.46 $46.92 55-59 $14.87 $29.74
60-64 $29.13 $58.26 60-64 $18.80 $37.60
65-69 $35.04 $70.08 65-69 $22.59 $45.18
70-74 $49.56 $99.12 70-74 $30.15 $60.29
75-79 $63.20 $126.40 75-79 $39.94 $79.88
80-84 $71.46 $142.92 80-84 $52.43 $104.86
85+ $122.65 $245.30 85+ $56.51 $113.02
Child Critical Illness
Age $2,500 $5,000
0-26 $1.42 $2.84
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 13Hospital Indemnity
Administered by:
You may also elect Hospital Indemnity Insurance. This insurance pays benefits for a covered hospital stay resulting
from a covered injury or illness. Coverage continues after the first hospital stay so you have additional protection for
future hospital stays.1,2
You can use the money however you’d like.2 For example, it can help you pay for expenses related to:
• Medical bills not covered by your health plan
• Childcare
• Travel
• Other out-of-pocket expenses
There are no copays, deductibles, coinsurance or network requirements.
Additional Hospital Indemnity Benefits:
• Benefit schedule is per occurrence
• Elections can be made for Employee, EE+SP, EE+CH or Family coverage
• Covered hospitalization includes items such as:
o Hospital Admission o Hospital Stay
o Hospital Intensive Care Unit o Hospital Observation
Stay
• Wellness and Health Screening Benefit – Benefit of $50 per covered person, per calendar year, for a health
screening or diagnostic test.
o Eligible tests include (but are not limited to) mammography, general health exams and certain blood
tests.
• Pre-Existing Conditions – 6 months prior to effective date, pre-ex for 12 months
1. The term “hospital” does NOT include a clinic, facility or unit of a hospital for: (1) Rehabilitation, convalescent, custodial, educational, hospice or skilled nursing
care; (2) the aged, drug addicts or alcoholics; or (3) a facility primarily or solely providing psychiatric services to mentally ill patients.
2. Benefits may be paid directly to the hospital on assignment
* These are examples only. Refer to your plan materials for the features of your specific plan. To receive benefits, the event must meet the terms and definitions
of the policy. Waiting periods and frequency limitations may apply. Subject to all other plan exclusions and limitations.
Hospital Indemnity
Monthly Rates
Employee $19.70
Employee+Spouse $36.94
Employee+Child(ren) $34.28
Family $51.22
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 14Flexible Spending Accounts
Administered By:
Health Care Reimbursement Account
Health Care Reimbursement Accounts (FSAs) allow you to pay for eligible dental, vision and/or dependent care expenses on a pre-tax basis,
meaning your FSA contributions are deducted from your pay before your federal and Social Security taxes are calculated. The result is that
your taxable income is reduced, and you get to keep a greater portion of your paycheck. Eligible expenses must be incurred between January
1, 2021 – December 31, 2021. It is important to keep all receipts as you will be asked to substantiate your claims.
Employees who are NOT enrolled in the ECS Health Plans as well as employees who are NOT eligible to contribute to Health Savings Accounts
(HSAs) are eligible to participate in the Health Care Reimbursement Account. You are able to contribute up to $2,600 per year.
Dependent Care Reimbursement Account
Dependent care reimbursement accounts allow you to pay for eligible dependent care expenses on a pretax basis, meaning your FSA
contributions are deducted from your pay before your federal and Social Security taxes are calculated. The result is that your taxable income is
reduced, and you get to keep a greater portion of your paycheck. Eligible expenses must be incurred from Jan. 1 to Dec. 31, 2021.
All eligible employees may participate and contribute up to $5,000 to a dependent care FSA. These funds can be used to pay for dependent
care services, such as preschool, summer day camp, before- or after-school programs, and child or elder day care.
Life and Disability Benefits
Basic Life and AD&D Coverage
We help our eligible employees maintain financial security by providing a group life and accidental death and dismemberment (AD&D) benefit.
The cost of this benefit is shared by ECS and employees with employees paying 10% and ECS paying 90%. If you did not elect this benefit during
your new hire enrollment period, you can elect it later, but you will have to provide evidence of insurability.
Voluntary Life
You have the option to purchase Voluntary Life Insurance for you, your spouse and your eligible children.
Employee Benefit
Benefit Increments $10,000
Benefit Maximum Lesser of 5x’s Salary or $500,000
Guarantee Issue $100,000
Spouse Benefit
Benefit Increments $5,000
Benefit Maximum Lesser of $250,000 or 50% of Employee’s
Guarantee Issue Coverage
$50,000
Child Benefit
Birth to 6 months $500
6 months to 26 years Units of $1,000 to $10,000
Guarantee Issue $10,000
Disability Coverage
Short-Term Disability insurance is available to all employees working a minimum of 30 hours per week and certified staff working a minimum of
20 hours per week. The weekly benefit is 60% of earnings, not to exceed a $1,000 weekly maximum. Employees pay 100% of the Short-Term
Disability premiums.
Long-Term Disability insurance is available to all employees working a minimum of 30 hours per week and certified staff working a minimum of
20 hours per week. The monthly benefit is up to 66.67% of your monthly covered earnings not to exceed $7,500 per month.
If you apply for disability insurance more than 31 days after you become eligible, you will be asked to submit Evidence of Insurability
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 15Employee Assistance Program
Life can provide challenges. Usually people can work them out, but sometimes the problems are too much to be handled alone.
They begin to affect personal happiness, family relationships and good health. Often, they spill over into work and affect job
performance. Without proper help, these issues can become worse and result in tardiness, absenteeism, accidents, medical
expenses and even loss of job. Bowen Center helps thousands of people each year to cope and find solutions for life’s problems.
Good employees are our most valuable asset. Elkhart Community Schools provides an Employee Assistance Program (EAP) as a
benefit for and an investment in our employees. Bowen Center’s EAP works with ECS to provide confidential, professional
assistance to employees and their families to help resolve problems that affect their home life and job performance.
A Bowen Center EAP counselor will meet with you to help identify the personal problem that is interfering with work performance
and work with you towards a resolution. Bowen Center’s EAP also offers preventive services and crisis counseling.
Understanding your EAP
Who has access to this Employee Assistance Program (EAP)?
All Elkhart Community Schools employees are eligible for the EAP. A Bowen Center EAP also covers the employee’s spouse and
dependent children. Counseling does not have to be work-related and can be used for an individual, couples, a family, and more.
What locations are available for counseling?
For convenience and privacy, you may choose any Bowen Center Outpatient Counseling office location in Huntington, Fort Wayne,
Columbia City, Warsaw, Wabash, Syracuse, Albion, Lagrange, Angola, Auburn or Plymouth, Indiana.
Is prior authorization required?
No. There is no co-pay or deductible. All sessions under the EAP are prepaid by Elkhart Community Schools.
What is not covered?
Services excluded from EAP coverage are medication management, psychological testing, psychiatry visits, inpatient treatment and
any court ordered treatment.
Is my employer informed if I use the EAP?
No. All sessions are private and confidential. Due to privacy laws, no protected health information is given to your employer
without your ex-pressed written consent.
How do I set an EAP appointment?
Call Bowen Center at (800) 342-5653 to schedule an appointment. State that your employer is Elkhart Community Schools and that
you would like to schedule an EAP visit. Note: Your insurance information may be gathered to make sure you are scheduled with a
covered provider should you choose to continue beyond your EAP covered sessions. You will not be charged for sessions covered
by your EAP.
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 16Employee Enrollment Guide
BEFORE YOU BEGIN ENROLLING IN YOUR BENEFITS, YOU WILL NEED TO HAVE THE FOLLOWING INFORMATION ON HAND.
• Your social security number and social security numbers of your eligible dependents.
• Your date of birth and the dates of birth for your eligible dependents
• Beneficiary Information for your Life/AD&D and Voluntary Life Plans
Step 1: Access and Log On
Type or paste the link into your web browser’s search bar:
https://benefits.plansource.com/logon
USERNAME: First initial of your first name, the first six characters of your
last name and the last four (4) digits of your SSN.
Example: John Employee – SSN – 000-00-1234
Username would be jemploy1234
PASSWORD: When you log in, your password will be your birth date in the
format YYYYMMDD. Example: February 7, 1975 would be 19750207.
You will be prompted to change your password. Enter the new password
and click save.
Step 2: Review Profile & Dependent Information
Fields with an asterisk are required.
• Verify Personal Information and make changes if needed.
• Click, Next: Review My Family. On this page you can add, edit or
remove dependents.
Step 3: Shop for Benefits
• The first screen is the Certification and Authorization screen.
Click ‘I Agree’ and ‘Confirm’.
• Select family members to add to coverage then click ‘Confirm.’
• View a Plan: If you would like to quickly view a particular benefit
plan’s cost per pay period, simply click ‘View Plan’.
• Compare Plans: Check the compare box below the plans you
want to compare and click ‘Green Compare Box.’
• Enroll in a Plan: To select a medical plan, click ‘View’ and Update
Cart. Or, click ‘Decline’ to waive enrollment. To select Dental
and/or Vision – Confirm Plan or Decline
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 17STEP 4: Add or Update Beneficiaries
If you have selected a plan that requires a beneficiary, i.e. Life, AD&D, you
will be prompted to complete the fields on the Beneficiary screen. Please
complete all information for both primary and secondary (if necessary)
beneficiaries.
• To begin, click ‘Add Beneficiary’ to add a new record.
• Complete the information requested in the beneficiary record.
• Finally, designate a percentage for each primary and secondary
beneficiary (if applicable).
• When you have completed this information, click ‘Save’ at the
bottom of the screen.
STEP 5: Benefit Confirmation Statement
• After all screens have been completed, click ‘Review and
Checkout’ at the bottom of the screen. This will take you to a
summary of your benefit elections.
• You can adjust your plan selections until your enrollment period
is closed. If you need to adjust your elections, click, ‘Change
Plan’ next to the benefit you want to change.
• After all adjustments are made click, ‘Checkout’.
CONGRATULATIONS! YOU HAVE COMPLETED THE ENROLLMENT PROCESS AND CONFIRMED YOUR BENEFITS
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 18Contacts
Topic Contact Phone Number Website / Email
Insurance Secretary Julie Crane 574-262-5527 jcrane@elkhart.k12.in.us
Medical Coverage UMR 800-207-3172 www.umr.com
Prescription Drug
CVS – Caremark 888-202-1654 www.caremark.com
Coverage
Dental Coverage Delta Dental 800-524-0149 www.deltadentalin.com
Health Savings 574-206-0010 www.tcunet.com
Teachers Credit Union
Account (HSA) ext. 5702 bstauffer@tcunet.com
This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. If any conflict should
arise between this summary and the Plan, the Plan's Certificate will govern in all cases. 19You can also read
